ISSN:0961-7671    

DOI:10.1111/j.2042-7174.1995.tb00790.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

Research on the placebo effect and its hypothetical relationship to adherence and improved patient outcomes is reviewed. Future research for pharmacists is highlighted. Clinicians and researchers have alternately attempted to suppress, control for and maximise the placebo response. Much research has been conducted to identify the placebo responder. The placebo response is seldom uniform, constant or predictable, and neither sex, age, intelligence, ethnic, cultural or social factors are predictive of it. However, no research has investigated the relationship of adherence, placebo effects and patient outcomes. Adherence to therapy and its role in activating the placebo response is described. Efforts to increase adherence may increase treatment effectiveness by activating the placebo response. The pharmacist may be in an ideal position to better understand the placebo effect and its role in enhancing patient outcomes. The placebo effect, thus, may be a useful part of the care giver's armamentarium.

ISSN:0961-7671    

DOI:10.1111/j.2042-7174.1995.tb00791.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

ISSN:0961-7671    

DOI:10.1111/j.2042-7174.1995.tb00792.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

During the past decade, there has been much discussion about the role of the community pharmacist in health education. This paper is based upon interviews with a small sample of practising community pharmacists. It reports on their perceptions of the nature of their health education role, the practicalities of implementing this role and the obstacles that need to be overcome.The pharmacists were clear about their health education role as it related to advice on prescribed medicines. However, they were uncertain about other aspects of the health education role. These uncertainties are related to their education in a biomedical and functionalist paradigm together with ethical concerns about interference in the lifestyles of patients. Both these aspects influence the manner in which pharmacists communicate.The paper discusses the need for further advances towards patient orientated pharmacy, which is the essential direction for a health education role.

ISSN:0961-7671    

DOI:10.1111/j.2042-7174.1995.tb00793.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

A “top down” analysis was used to identify the therapeutic areas making major contributions to the greater than £22m increase in general practitioner prescription costs in the former South Western regional health authority (RHA) between the years ending August, 1992, and August, 1993. The analysis used PACTLINE and level 3 PACT to identify the British National Formulary (BNF) chapters and sections most responsible for cost increases. In support of this analysis, a “bottom up” analysis was also carried out. This involved empirically selecting therapeutic areas that might have made significant contributions, then calculating, using levels 2 and 3 PACT, the extent of the contribution.Despite the different approaches, several classes of agents were identified by both methods. The top down analysis indicated that just six therapeutic areas had contributed almost £11m to the total increase of £22m+: they accounted for over 100 per cent of the “excess” growth in the four high growth rate BNF chapters (1, 3, 4 and 6). As various authoritative guidelines have recently been published concerning the use of many of the drugs in these therapeutic areas, the bases exist for a detailed evaluation of whether or not the large increases in their use can be justified.Analysis of prescriptions dispensed for medicines in chapter 2, which served as a control because of a large increase in prescription numbers but a below average increase in costs, supported the contention that the increased use of generic products and/or some sort of price control (eg, their inclusion in the Drug Tariff) can release considerable resources to be exploited, allowing the introduction of newer and more expensive drugs even in situations of tightly‐co

ISSN:0961-7671    

DOI:10.1111/j.2042-7174.1995.tb00794.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

A postal questionnaire seeking the views of all Grampian general practitioners (n=314) to a proposed wider role for pharmacists obtained an 85 per cent response rate. The questionnaire consisted of prescribing related and general tasks compiled from the recommendations of the joint working party's report “Pharmaceutical care: the future for community pharmacy” and those identified by a local GP and pharmacist while working on a joint study.The overall opinion of GPs was in favour of increasing the role of pharmacists. They were most likely to support a routine service for the disposal of unwanted medicines, provision of compliance aids under the NHS and a formal system for pharmacists to report adverse drug reactions. GPs were least likely to support the selection of medicine and dosage by a pharmacist following agreed protocols, an NHS funded pharmaceutical adviser within surgeries to counsel patients on the use of medicines, or the provision of diagnostic and screening services by pharmacists. It is concluded that there is a potential for the integration of the community pharmacist within the traditional primary health care team. Roles have been identified that are acceptable to GPs and which could bring job satisfaction to pharmacists, whose specialist knowledge of drugs is currently under‐uti

ISSN:0961-7671    

DOI:10.1111/j.2042-7174.1995.tb00795.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

Extemporaneous preparations are drugs that are compounded for individual patients or made in larger batches for stock‐keeping. This study aimed to analyse factors associated with the prescribing of such preparations in Sweden.Information was taken from the Swedish diagnosis and therapy survey for the time period October, 1986, to September, 1988, inclusive. This survey collects from a random sample of doctors the details of all prescriptions they write during one week, as well as all corresponding diagnoses. The present study analysed extemporaneous prescriptions and the characteristics of doctors issuing them.Of the 2,142 doctors who contributed prescriptions to the survey, 19 per cent wrote at least one prescription for an extemporaneous preparation. Young patients obtained such preparations more than older patients. Proportionately fewer of the youngest doctors prescribed them. Dermatologists prescribed extemporaneous preparations much more commonly than other doctors, and most of the preparations concerned were dermatologicals. The most common diagnosis for the prescribing of these preparations was contact eczema, with psoriasis second. The findings suggest that the prescribing of extemporaneous preparations is established and continuing and not just a feature of obsolete practice. However, the appropriateness of these products should be further analysed and assessed to ensure that they are clinically and pharmaceutically safe and effectiv

ISSN:0961-7671    

DOI:10.1111/j.2042-7174.1995.tb00796.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

Poor compliance with contact lens care regimens is a factor considered important in the development of potentially sight‐threatening microbial keratitis. The purpose of this study was to highlight particular areas of non‐compliance in contact lens care. One hundred and sixty contact lens wearers, who presented to an ophthalmic casualty department over a period of six months, were surveyed using a self‐administered questionnaire. Of the 142 patients who used daily wear lenses, 29 (20 per cent) did not clean/disinfect their contact lenses after every use. Soft contact lens wearers used a wide variety of care regimens, some of which would be ineffective in disinfecting the lenses. The care of the lens case was a particular problem, with only 10 patients (7 per cent) using a regular and effective method of case cleaning. Seventy‐three patients (50 per cent) either rarely or never discarded their contact lens solutions 28 days after opening. Of the 128 patients wearing non‐disposable lenses, 43 (34 per cent) either rarely or never used enzymatic cleaning tablets to remove protein from their lenses. Tap water, a potential source of microbial contamination, was used for rinsing contact lenses before or after cleaning by 36 patients (25 per cent). The results highlight specific areas where there was deviation from recognised standards of practice for contact lens care. There is a need for contact lens wearers to be re‐educated in the care of their lenses. Since pharmacies are a major source of contact lens care products, pharmacy staff could have an important role to play in the counselling of contact lens wearers to help prevent serious ocular

ISSN:0961-7671    

DOI:10.1111/j.2042-7174.1995.tb00797.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

As the role of the pharmacist develops, expands and changes, it is crucial that those involved in the provision of education and training programmes address areas of current need. One such area is that of delivering presentations to groups, since this is a task which pharmacists are increasingly expected to perform. This paper describes a communication skills training (CST) course for pharmacists, targeting on the area of presentation skills. Starting with a brief overview of the content of the course, where five specific presentation strategies are elaborated, the article goes on to describe the key instructional techniques used. Programme evaluation was through analysis of a post‐course questionnaire designed to assess the perceived effects of the training on participants. Against the stated criteria the course achieved an overall 85 per cent score. Strategies for introducing, structuring and concluding a presentation, and for defining new terms scored highest in terms of skill use outcome whereas techniques for engaging audience participation obtained the lowest scores. The implications of these results are discussed, together with recommendations as to how this type of training can be optimise

ISSN:0961-7671    

DOI:10.1111/j.2042-7174.1995.tb00798.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

The aim of this study was to examine costs of charted drugs by using three data capture techniques. Data were manually extracted retrospectively from drug charts for a stratified sample of 200 inpatient stays at each of two London hospitals — a teaching hospital (St George's) and a district general hospital (Kingston). Specialties where costing was not feasible were excluded. These were: intensive care, oncology, dermatology and paediatrics. Three costs were calculated: nonstock drugs administered (the capability of traditional pharmacy computer systems), drugs prescribed (the data captured by a basic computerised prescribing system) and drugs administered (the data captured by a drug administration recording system). Pharmaceuticals not prescribed on the drug chart, such as anaesthetics, contrast media and disinfectants, were not included.At St George's 2,739 and at Kingston 2,843 prescription entries were recorded, amounting to costs of £2,940 and £2,327, respectively, for drugs administered. A range of £0.01 to £171 per patient (median £4.67) at St George's and £0.00 to £122.66 (median £2.88) at Kingston demonstrates a skewed distribution, with most patients incurring low costs. Non‐stock drugs accounted for 21 per cent of the cost of drugs administered at St George's and 15 per cent at Kingston. Twenty‐four patients incurred costs above £50, their non‐stock drugs being a mean of 21 per cent of their total costs. The cost of drugs administered at both hospitals was found to be 95 per cent of the cost of drugs prescribed.Computerised prescribing and drug administration recording systems would significantly improve cost allocation. However, it is unlikely that the expense could be justified on the basis of the low value of drugs received

ISSN:0961-7671    

DOI:10.1111/j.2042-7174.1995.tb00799.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY